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47 Cards in this Set
- Front
- Back
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Aqueous fluid
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absorbed by the visceral pleural capillaries
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Protein phase
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absorbed by the parietal pleural lymphatics
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Exudate
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-more than 1/2 protein
-more than 6/10 lactate dehydrogenase -formed by active abnormal cellular process |
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Causes of exudate
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-infections: TB, fungus, penuemonia
-CA -PE -uremia -drug reaction -others |
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Transudate
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passive movement of fluid resulting from 3 physiologic phenomina:
-increased hydrostatic pressure -decreased plasma oncotic pressure -increased neg. intrapleural pressure |
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causes of transudate
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-CHF
-Nephrotic syndrome -acute atelectasis -PE |
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Empyema
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a form of exudate
-fluid is turbid or purulent due to infx in the pleural space itself |
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Hemothorax
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-gross blood in the pleural space
-usually due to chest trauma |
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Chylothorax
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milky appearance due to cholesterol complexes
-should be centrifuged: if top is clear, its empyema, not its chylothorax |
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small effusions
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usually asymptomatic
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Large effusions
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S/S
-dyspnea -decreased breath sounds and femitus -dullness to percussion -massive: may push the trachea to opposite side |
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X-Ray findings
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-thickening of interlobal and /or interlobular lung fissures
-loculate fluid -crescentic line or meniscus |
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Transudate: treatment
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treat underlying condition
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Exudate treatment
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tube thoracostomy
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hemorthorax treatment
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usually one or more chest tubes
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Bronchiectasis
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the pathologic expansion of the bronchi or bronchioles resulting from chronic necrotizing infections caused by various conditions that destroy the bronchiole smooth muscle and elastic tissue
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Bronchiolectasis: S/S
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-cough
-expectoration of copious purulent, sometimes fetid sputum -flecks of blood, if not frank hemoptysis |
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causes of bronchiectasis
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-Obstruction:
-tumor -foreign body -mucus impaction -cystic fibrosis -HIV / or other immunodef. -Pneumonia |
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pathogeneis of bronchiectasis
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obstruction and chronic infx
-usually effects lower lobes -mixed flora |
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bronchiectasis: labs
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thin section CT shows dilated airways
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X-Ray: bronchiectasis
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-shows increased bronchovascular markings from:
-peribronchial fibrosis -intrabronchial secretions |
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clinical sign
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finger clubbing
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Treatment: bronchiectasis
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-ABX
-bronchodilators -resp. therapy -vibropercussion -exercise & breathing ex. -pursed lip breathing -O2 therapy -avoid smoking/sedatives/antitussives |
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Primary (ideopathic) Pulmonary HTN
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-rare, mostly young women
-progressive dyspnea: death in 2-8 years -unknown cause, see diffuse narrowing of pulomonary arterioles |
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Secondary pulmonary HTN
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-vasoconstriction: chronic dyspnea
-loss of pulmonary vessels -vascular obstruction -increased pulm. venous pressure -increased blood viscosity |
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Loss of pulmonary vessels: causes
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-emphysema
-vasculitis -pulmonary fibrosis -autoimmune disease (RA,SLE) |
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Vascular obstruction
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-pulmonar emboli
-tumors -foreign bodies |
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increased pulmonary venous pressure
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-increased mitral stenosis
-constrictive pericarditis |
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increased blood viscosity
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-polycythemia
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S/S pulmonary HTN
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-dyspnea
-fatigue -chest pain -syncope on exertion |
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Pulmonary HTN: lab findings
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-hypoxemia
-polycythemia in many cases -ECG shows -R atrial enlargement -R ventricular strain -RVH -RAD -V/Q scan: may show defects -PFT's no routine changes |
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Pulmonary HTN: Treatment
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-NO real effective treatment
-periodic phlebotomy if polycythema and hematocrit >60% -prostacyclin |
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Pneumothorax
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seperation of the visceral and parietal pleurae by volume of air
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Primary spontaneous PTX
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occurs in the absence of underlying lung disease
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Secondary Spontaneous PTX
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occurs in complications of lung disease
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Traumatic PTX
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-blunt or penetrating trauma
-iatrogenic causes -subclavian or internal jugular vein catheterization -thoracentesis -percutaneous lung Bx -pulm. barotrauma from mech. overventilation - |
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Tension PTX
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-air enters thorax during inspiration but does not exit on expiration
-positive interpleural pressure> ambient pressure -may be due to trauma, CPR or mechanical ventilation |
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Primary PTX
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-often tall, thin boys
-thought due to rupture of subpleural apical blebs due to high pleural pressure -smoking increases risk |
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Secondary PTX
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-associated with other lung diseases:
-pneumonia -TB, CF -Asthma |
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Catamenial PTX (secondary)
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-assoc. with onset of menses +/- 3 days
-assoc. with intrathoracic endometriosis |
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PTX general S/S
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-chest pain, minimal to severe on affected side
-perhaps mild tachycardia -if large: -breath sounds, fremitus decreased -asymmetric chest expansion -hyperresonance or tympany on chest percussion |
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Diagnosis of PTX:
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suspect if:
-severe dyspnea & marked tachycardia -tracheal or mediastinal shift -systemic hypotension -widespread percussion hyperresonance or tympany |
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LABS for PTX
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-ABGs show hypoxemia & acute resp. alkalosis
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CXR for PTX
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-viscereal pleural line = defninitive dx
-may see pleural effusion, blunting of costophrenic angle -may see shift of tracheal air column TOWARD a NL PTX -may see shift of tracheal column & mediastinum AWAY from a tension PTX |
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Possible complications of PTX
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-subcutaneous emphysema
-pneumonmediastenum on CXR |
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PTX treatment: Small (<15% of hemithorax)
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-may only observe
-O2 supplementation may increase rate of air reabsorption -Aspiration -thoracostomy -serial CXRs q24 hr to follow |
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PTX treatment: Large
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-admit to hospital
-thoracostomy with underwater seal drainage and suction until lung expands on serial CXR |
